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► Med Misc 44 > Renal system > Flashcards

Renal system Flashcards

1
Q

what hormone controls Na+?

A

aldosterone

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2
Q

what hormone controls amount of water?

A

ADH

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3
Q

the kidneys have a major influence on what hemodynamic

A

blood pressure

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4
Q

what is the functional unit if the kidney

A

Nephron

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5
Q

metabolic end-prodeucts are excreted how?

A

filtration

(they are filtered into, and then trapped within, the renal tubule)

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6
Q

Renal Functions:

what are the main electrolytes the kidney balances?(5)

A

Na+

K+

Ca++

Mg++

Cl-

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7
Q

Renal Functions:

what 2 things does it control for acid base balance?

A

H+

HCO3-

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8
Q

Renal Functions: regulation of osmolality

________ are 90% of total osmolality of the ECF

A

sodium salts

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9
Q

Renal Functions: regulation of osmolality

when we talk about regulating osmolality, we are talking about regulating what?

A

Sodium concentration

(b/c sodium salts represent 90% of total osmolality)

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10
Q

Renal Functions: regulation of osmolality

what is normal osmolality? give normal and range!

A

normal 300 mOsm/kg

range 270-310 mOsm/kg

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11
Q

Renal Functions:

what are 6 non-volatile end products of metobolism excreted

A

HP04 –

SO4 –

urea

Creatinine

uric acid

lactic acid

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12
Q

Maintenance of ECF volume is acheived by controlling what 2 things

A

salt NaCl

and

water excretion

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13
Q

the kidneys are considered endocrine why?

A

they produce hormones

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14
Q

What 3 hormones to the kidneys produces

A

Erythropoietin

Renin

Vitamin D

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15
Q

Endorince functions:

what does erythropoietin do?

A

acts on bone marrow and stimulates RBC production

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16
Q

Endorince functions:

whay is a pt with chronic renal failue anemic

A

decreased production of erythropoietin

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17
Q

Endorince functions:

what is the purpose of renin

A

enzyme that participates in blood pressure regulation, potassium ecretion, and sodium reabsorption

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18
Q

Endorince functions:

function of vitamin D

A

the kidney w/ help of the liver convert Vit D into its active form Vit D3

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19
Q

Endorince functions:

why does a chronic renal pt become hypocalcemic

A

b/c absorption from the intestine is impaired when there is a vit d if difficient

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20
Q

Renal Blood flow:

the kidney receives what % of CO

A

25%

1.25 L/min

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21
Q

how do the kidneys autoregulate

A

they have 2 sets of capillaries, the dual function allows for control of flow and pressure

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22
Q

Label

A
  1. Efferent Arteriole
  2. proximal convoluted tubule
  3. Loop of henle
  4. Afferent Arteriole
  5. Distsal convoluted tubule
  6. Collecting duct
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23
Q

Point or explain where each diuretic works

CAI

Loop

Thiazides

K+ sparing

A

CAI- proximal tubule

Loop- thick Ascending loop oh henle

Thiazide- distal tubule

K-sparing- collecting duct

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24
Q

point to the bowmen’s capsul

A
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25
Q

point to the glomerulus

A
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26
Q

three functions of the kidney

A

filtration

reabsorption

secretion

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27
Q

what is the function of the proximal tubule

A

reabsorbs the bulk of the filtered fluid and it’s dissovled contents

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28
Q

what is the function of the Loop of Henle

A

establishes and maintains an osmotic gradient in the medulla.

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29
Q

what is the function of the distal tubule and collecting ducts?

A

make final adjustments on urine pH, osmolality, and ionic composition

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30
Q

the LOH is a COUNTERCURRENT MULTIPLIER which does what

A

creats the osmotic gradient

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31
Q

the vasa recta is a COUNTERCURRENT EXCHANGER whch does what?

A

Maintains the osmotic gradient of the LOH

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32
Q

the Thick acending LOH is impearmeable to what?

A

water

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33
Q

explain the osmolality of the cortical and medullary tissue from cortex to inner medulla

A

in the cortex osmolality 300

in the outer medulla increases from 400 - 600

in the inner medulla increass from 800 to 1200

The osmolality increases as it travels throught the nephron

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34
Q

picture to expain osmolality of cortical and medullary tissue

A
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35
Q

deposition of Na+ into the medullary interstitium by the TAL of henle can increase the interstitial osmolality to 600 mOsm/kg. where does the additional 600 come from- for a total of 1200 at the tip of the medullary pyramid?

A

urea

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36
Q

the bullk of the glomerular filtrate (67%) is reabsorbed by what?

A

proximal tubule

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37
Q

Renal control of glucose:

what part of the nephron has the maximum capacity for reabsorbing glucose

A

proximal tubule

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38
Q

Renal control of glucose:

just to read and understand

A

the proximal tubule has the maximum capacity for reabsorbing glucose; this maximum reabsorption capacity is referred to as the transport maximum (Tm). all of the filtered glucose is normally completly reabsorbed from the the proximal tubule y active transport mechanisms. the amount of filterd glucose normally does not exceed the transfer (transport) maximum. in untreated DM, the amount of glucose filtered exceeds the transfer (transport) maximum of the proximal tubule. glucose that escapes reabsorption from the proximal tubule is excreted. all segments of the renal tubule beyond the proximal tubule are impermeable to glucose.

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39
Q

picture to explaint the renal control of glucose

A
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40
Q

what happens to urine output in the untreated pt w/ DM? why?

A

UOP increases, bc unfiltered glucose load exceeds the transport maximum; glucose the remains in the tubular fluid after PCT causes osmotic diuresis

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41
Q

renal control of water excretion:

the rate of ADH released into the bloodstream is directly related to the what of the ECF?

A

osmolality

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42
Q

renal control of water excretion:

besides osmolality, what other 2 things can trigger release of ADH

A

decreases in ECF volume

stressors (pain)

43
Q

renal control of water excretion:

an INCREASE in ECF osmolality is corrected how

A

ingesting water and adding to the ECF

44
Q

renal control of water excretion:

a decrease in ECF osmolality is corrected how

A

by excreting water and removing it from ECF

45
Q

renal control of water excretion:

ECF osmolality (hence sodium concentration) is regulated by what?

A

ADH

also called AVP (arginine vasopressin)

46
Q

AVP/ADH:

synthesized where?

A

hypothalamus (paravetricular and Supraoptic nucleus)

47
Q

AVP/ADH:

stored where

A

post pituitary

neurohypophysis

48
Q

AVP/ADH:

secreted into what

A

blood

49
Q

AVP/ADH:

stimulus for release

A

increased Na+

Increased osmolality

50
Q

AVP/ADH:

site of action

A

collecting ducts

51
Q

2 hormones the neurohypophysis releases

A

ADH

Oxytocin

52
Q

6 hormones the andenohypophysis releass

A

GH

ACTH

FSH

Prolactin

LH

TSH

53
Q

how do you tell the orientation of the pituitary gland in a picture

A

CN II the optic chiasm (anterior)

54
Q

in response to an increase in ECF osmolality what occurs

A

paraventricular and supraoptic nuclei shrink and nerve axons fire action potential, which cause AVP/ADH release from the neurohypophysis

55
Q

what is the most powerful stimulus for triggering the release of AVP/ADH

A

increase in ECF osmolality

56
Q

when AVP/ADH reaches the collecting duct what occurs

A

reabsorption of water increases

57
Q

in response to a decreas in ECF osmolality what occurs in the hypothalamus

A

cells of the paraventricular and supraoptic nucli swell and nerve action potentials are inhibited so AVP/ADH release is depressed.

58
Q

in the absence of AVP/ADH what happens in the collecting ducts

A

they are impeameable to water and a large volume of dilute urine if formed

59
Q

any stress (hypovolemia, hypotension, pain, emotional) will cause what regarding the release of AVP/ADH

A

lead to an increase in the release

60
Q

extracellular fluid volume:

what is the major determinant of ECF volume

A

amount of Na+ in the body

61
Q

extracellular fluid volume:

what is the most important hormone in regulating ECF volume

A

aldosterone

62
Q

aldosterone is produced where?

A

zona glomerulosa of the adrenal cortex

63
Q

where does aldosterone work

A

distal convoluted tubule

64
Q

what does aldosterone do?

A

increases the rate of Na+ REABSORPTION, therby decreases the rate of Na+ elimination

65
Q

what does aldosterone do to K+

A

increases the rate of K+ secretion into the late DCT and collecting duct therby increasing the rate of K+ excretion

66
Q

when sodium intake is high, the body Na+ content increases, and the body fluids become concentrated. ADH/AVP output increases to conserve water, and thirst causes water ingestion, which stores osmolality but expands fluid volume

A
67
Q

what is the majar consequence of sodium retention

A

ECF volume expansion (hypervolemia)

and arterial bp to increase

68
Q

a picture of body’s response to increased sodium

A
69
Q

when the bodies sodium intake is low, the body sodium content decreases, and the body fluids become dilute. AVP/ADH output decreases, and a dilute high volume urine is formed. osmolality is restored, but fluid volume is contracted

A
70
Q

what is the major consequence of Na+ loss?

A

fluid volume contraction (hypovolemia)

decreased arterial bp

71
Q

picture showing body’s response to low Na+

A
72
Q

Diuretics:

name some loop diuretics

A

Furosemide (lasix)

Bumetanide (Bumex)

Torsemide (demadex)

73
Q

Diuretics: Loop

where do they work

A

Acending LOH

74
Q

Diuretics:​ Loop

how do they work?

A
  • the LOH simultaneously transports Na+, K+, and 2Cl- in the same direction (termed Na+, K+, 2Cl- symporter)
  • Loop diuretics bind to the Na+, K+, 2Cl- symported and inhibit the reabsorption of these ions from the ascending LOH
  • the amount of H20 reabsobed is reduced and watyer excretion increases
75
Q

Diuretics:​ Loop

Side effects of Loop diuretics

A
  • Hypokalemia
  • Fluid volume deficit
  • Orthostatic hypotension
  • reversibel deafness
76
Q

Diuretics:​ Loop

why can bp fall even before UOP increases

A

bc they trigger the release of prostaglandins that cause venodilation, the decreased prelad causes a decrease in bp

77
Q

picture of Loop diuretics

A
78
Q

diuretics that work on the DCT an dColecting duct work to inhibit what

A

Na+ reabsorption

79
Q

thiazides inhibit Na+ reabsorption where

A

early DCT

80
Q

where does spiralactone work

A

late DCT, early collecting duct (go with collecting duct)

81
Q

spironolactone competively inhibits what?

A

aldosterone

82
Q

give an ex on a Carbonic Anhydrase Inhibitor

A

Acetazolamide (diamox)

83
Q

Carbonic Anhydrase Inhibitor inhibits what

A

the enzyme Carbonic Anhydrase

84
Q

Carbonic Anhydrase Inhibitor works where

A

PCT

85
Q

Carbonic Anhydrase Inhibitor does what to Intraoccular pressure and how

A

decreases the formation of aques humor, this decreaseing intraocular pressure.

86
Q

Acute Kidney Injury:

formally called what

A

acute renal failure

87
Q

Acute Kidney Injury:

periop renal failure accounts for ____ of all pts requiring acute dialysis

A

half

88
Q

Acute Kidney Injury:

3 types

A

prerenal

intrarenal

postrenal

89
Q

Acute Kidney Injury:

3 causes of prerenal

A

decreased renal blood flow

Hypovolemia

Decreased CO

(anything that occurs befor blood gets to kidney)

90
Q

Acute Kidney Injury:

4 causes of Intrarenal failure

A
  • renal tubular damage (tubular necrosis)
  • Renal ischemia d/t prerenal causes
  • Nephrotoxic drugs
  • release of hemoglobin or myoglobin

(anything that occurs inside the kidney)

91
Q

Acute Kidney Injury:

3 causes of postrenal failure

A
  • Obstruction of urine flow
  • Bilat ureteral obstrution
  • extravasation d/t bladder rupture

(anything that occurs after the kidney)

92
Q

Acute Kidney Injury:

what is a syndrome triggered by hypoperfusion of the kidneys resulting in te rapid deterioration of renal function and accumulation of nitrogenous wastes (azotemia)

A

ischemic Acute renal failure

93
Q

Chronic Kidney disease:

normal GFR

A

125 ml/min

94
Q

Chronic Kidney disease:

GFR for decreased renal reserve

A

50-80 mL/min

95
Q

Chronic Kidney disease:

GFR for renal insufficiency

A

12-50 mL/min

96
Q

Chronic Kidney disease:

GFR for uremia

A
97
Q

Chronic Kidney disease:

what is the best test to show renal reserve

A

creatinine clearance (measures GFR)

98
Q

Chronic Kidney disease:

3 main complications

A

Anemia

Pruitus

Coagulopathies

99
Q

Chronic Kidney disease:

common electrolyte disturbances?

A

Hyperkalemia

Hypocalcemia

Hypermagnesemia

Hyperphosphatemia

100
Q

Chronic Kidney disease:

what is the most serious electrolyte disturbance

A

Hyperkalemia

101
Q

Chronic Kidney disease:

what fluid would u wanna avoid and why

A

LR

contains 4 mEq of k+

102
Q

Chronic Kidney disease:

avoid elective sx unless K+ is less than what?

A

5.5

103
Q

Chronic Kidney disease:

ways to treat hyperkalemia

A

Iv calcium

Hyperventilation

IV Insulin and glucose

IV Beta 2 agonist

IV loop diuretics

kayexalate

Dialysis

► Med Misc 44 (72 decks)

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